Taking the step from 7.0 A1C to a 5.7 A1C

Hey,
So I’ve been type 1 for 30 years and had a1c’s similar to yours and no complications. They’re starting to talk now that likely hood of complications is also possibly genetic but you’ll only do better if you have your diabetes under control. I do think a1c depends on the person and you have to take into account other factors beside the bg number. Are your daily bg’s up and down and all around? How often do you eat during the day, the 80-100 mg/dL goal is more for fasting bg, after eating a good goal would be 150 mg/dL or slightly lower. This would also depend on fitness level and exercise which would lower bg. So you really need to tailor your a1c goal for you and your lifestyle.

Hi @csb49
Can I ask what an example of what you eat in a day would be? I’m trying to get my A1C down to where yours is, it’s currently 7.2. I’ve done the low carb diets but worry I cut out too many carbs! Thanks in advance!

What do you think will happen if you cut too many carbs? Some of us eat very few carbs and I have not noticed any ill effects (and my endo supports carb restriction).

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Hi @Brian_BSC
In the past on low carb diets I’ve felt more lethargic. Your brain needs glucose to function so it makes sense to find a balance. Aside from that there could be repercussions on your kidneys from upping your protein- too much can be taxing on your organs. So I wonder where the safe balance lies. Of course, lower blood sugar numbers likely outweigh the risk of protein vs kidneys, etc. but I’m not a Dr and don’t know. What are your thoughts? Thanks for the response!

True as far as it goes. However—

  • The brain has its own emergency supply of stored glycogen, good for 20 minutes or so.

  • Like an athlete who trains at high altitude to prepare for an event in Denver or Mexico City, the body adjusts to a new regime. This is specifically true in the case of low carb diets; the empirical evidence is conclusive. See Volek and Phinney, just for example.

I have no idea why you are concerned about too few carbs. You can tell from your bg that your body has plenty, unless you are experiencing a low of course. Our brains don’t store much glucose so a “normal” bg is best. If your kidneys have no damage, protein is fine too.

Just remember, it’s not just food. I work out daily (until my bum knee started acting up I did at least 1/2 hour with www.jessicasmithtv.com every day - cardio, strength, yoga, Pilates - mix it up so you don’t get bored). I also got the books “Think Like a Pancreas” by Scheiner and “Using Insulin” by Walsh. When I was eating very low carb, I learned everything I could in them. I figured out all my ratios, basal and correction factors. It’s hard and takes lots of effort all the time.

I didn’t eat any bread, potatoes, corn or rice. For the most part, I eat them sparingly now. I ate eggs, bacon and whole fruit or veggies for breakfast. Dinner was a protein and big salad, some kind of creamy dressing (I like blue cheese). I use lots of low carb veggies in the salad - all different colors. If a salad was too much effort (it can be time consuming) just a microwaved bag of veggies. I hate lunch, but a protein and side salad or similar. Dessert was nuts and a few very dark chocolate chips, if necessary. There are hundreds of paleo and low carb recipe websites for help. Taco salads and buffalo wings work for junk food days.

Doing all that means you need to have food on hand - I shop often and cut up and store veggies for a few days. I plan well so there is little wasted food (I HATE to waste food!). I make menus and write shopping lists. It takes effort.

Once I figured everything out, I started adding in more carbs. I write down everything so I know what to do next time. We eat few things on a weekly basis - we usually eat the same/similar often. If it’s written down, you can find it. Of course, it’s never the same. I eat lots of sweet potatoes - fries, tots, latkes… They seem to work better for me than white potatoes. And they are yummy. Butternut squash is yummy too. Now I use sandwich thins for toast (1/2) and low carb tortillas for wraps and I make pizza frittata. I make lots of food using almond meal in place of flour.

Just remember, any diet you choose has to work long term. If you aren’t going to stick with it, find another way. I could have done the very low carb thing for a long time but not forever. The modified low carb I do now will work fine forever.

Get those books. They, plus the exercise with JS, have changed everything for me. It’s constant and difficult, but better than the roller coaster of highs and lows I had before. You need to decide to do it - it’s a life change, not just a diet.

Some people find that transitioning to a low carb diet causes them to feel tired. The theory is that it takes a while for the body to adjust to fat burning. It is also recommended that you increase salt intake as low carb diets cause the body to shed salt. It turns out that the IOM recommends that your brain needs 100g of carbs a day, but it turns out that is for someone who is glucose adapted. Your brain actually can operate quite well burning fat. And even if you still wanted to keep around 100g of day of glucose your body can produce that on it’s own.

And a low carb diet is not a high protein diet. A low carb diet is typically a low carb, modest protein and high fat diet. And high protein diets only pose a risk when you have compromised kidneys.

I’d recommend you give the low carb diet another try. Try to have bullion a couple times a day in the first few weeks and see if that helps the transition. Most people find that after 2 weeks they have more energy aren’t as hungry anymore and they have wonderful blood sugars.

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That certainly describes my experience. Getting through that first two weeks is the hard part. After that, it gets pretty nice.

Hi @csb49

Cant thank you enough for your input, that was so helpful. I met with my Dr today and after confirming my A1C hasn’t improved we agreed that I should give a new diet a try. I exercise 3-4x per week and hope to increase that as my sugar becomes more stable (I exercise first thing in the morning but have been waking up with high blood sugar numbers recently, it really puts a damper on my day.) I will absolutely order those books. Do you find that the different types of exercise affects you differently? I find that strength training makes me go high after.

Thank you so much for your advice!

Hi @Brian_BSC
Thank you very much for taking the time to respond. I spoke with my Dr and am going to give the lower carb diet a try to get better control, my A1C came back the same as last time and I really want it to be better. Very interesting about the salt intake, I would never have known that fact. Thanks again!

Hi @Kel1, if you don’t mind, I’m going to jump in here and offer my 2 cents. I basically do the exact same thing as @csb49 and my a1c has stayed below 6 since my original diagnosis at 10 (with the exception of my first holiday season with T1D, where I ended up with a 6.2 but that’s how I learned how much leeway I had with indulgences).

Don’t be concerned with not getting enough carbs. A good low carb diet is really just a matter of switching out starchy and low fiber carbs for vegetables and high fiber grains (if you choose to eat grains - I avoid them for the most part but when I do eat them I choose lentils/beans and sometimes quinoa). You’re still getting plenty of carbs. Low carb doesn’t mean no carb - just different foods.

I think one of the keys to maintaining a low carb diet long term is not skimping on other macronutrients (fat and protein). If you cut out a major portion of your diet, you’re going to be hungry and unhappy unless you replace it with something else.

A typical day for me (and honestly, this isn’t even that low carb when you add up the numbers, it’s just low glycemic):

Breakfast: 2-3 whole eggs, scrambled with a big handful of spinach, nitrite/nitrate free deli ham, 1/4 cup sweet potato, topped with half an avocado and a little sriracha. Black coffee.

Lunch: protein smoothie if I’m at home, or dinner leftovers if I’m out. My smoothie is usually some combination of unsweetened almond milk, protein powder, chia seeds, a tablespoon of natural almond butter or peanut butter, more handfuls of spinach, half a banana and about a handful of frozen berries. This is my highest carb meal usually, but it gives me a very nice, slow, rise in blood sugar because of all the fiber so it’s easy to cover with insulin.

Dinner: any combination of meat and vegetables. Like…a LOT of vegetables.

I usually snack on raw almonds in the morning if I’m hungry between meals because I don’t need a bolus for one handful. I’m also a sucker for cheese. And wine. So wine and cheese is a common snack while I’m getting dinner ready. No bolus necessary there, either. When I eat crackers with them, I get the Savory Thins from Trader Joe’s because they’re gluten free, and for some reason wheat seems to make my BG spike. Foods I completely avoid are rice, white potatoes, bread, and pasta. Oh, and I eat some dark chocolate pretty much every night for dessert :heart_eyes:

I do indulge once in a while, when I have a major craving for pizza or something. But I never expect it to go well. And it never does. Even if I guess my insulin correctly, I still feel like crap for at least the next 24 hours.

And I also agree that exercise is absolutely necessary to help increase your insulin sensitivity. Higher intensity exercise does make most people’s BG go up. With weight training, just take your time and take rests in between sets. Sometimes I get a small spike after lifting but I just keep an eye on it and it usually runs low later that day. Yoga and light aerobic exercise like walking are great for me. I hear running is notorious for increasing your BG.

Buy Think Like a Pancreas ASAP. It is my diabetes bible.

I hope this helps - I apologize if it’s overkill, haha, but the people on these forums have been such an incredible resource for me. I hope I can return the favor!

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Hi Kel - I can’t exercise before I eat. My bg doesn’t like it - so I eat breakfast and then work out. Lately it’s just a 45 minute walk due to my knee - I can’t do any lateral (side to side) work, so walking and biking are it. I don’t do high strength, just toning, so my bg usually does ok. When I try “lifting” it skyrockets, so I don’t. But every day can be different!! T1D can drive you crazy!!

I’m glad you are going to try it. I eat a lot more carbs now (and much heavier now!) and still maintain the under 6.0 A1C. But no white food - potatoes, rice, bread. It’s really not that hard - and eating at restaurants isn’t bad either. Just request extra veggies instead of the potato or other starch. Keep the sauces to a minimum - lots of odd hidden carbs in those.

You’ll do fine. Let us know how it goes. Get those books!!

KBJ - I’m glad to see another one doing the modified low carb thing. I eat so many veggies it gets a bit nuts sometimes. I can’t drink wine or champagne, such a bummer. But vodka with flavored seltzer works just fine (or flavored vodka and seltzer). I use unsweetened vanilla (or chocolate with peanut butter and no sugar added jelly on homemade flax crackers) almond milk. I had regular milk the other day and didn’t enjoy it at all. I admit to eating Cheerios, shredded wheat or oatmeal 2x per week now! Still maintain good A1Cs. I just couldn’t have eggs every day any more. Just be sure to measure each time. I do find on cereal mornings, my bg increases a few hours after walking and eating. I have to correct on those days, but that’s ok.

My current favorites are sweet potato/Parmesan tater tots and zucchini/sweet potato latkes. Yum. Roasted butternut squash and kale is good too. So many great recipes from the gluten free, low carb and paleo websites.

I make my husband white potatoes occasionally - like when I have butternut squash. When I make mashed cauliflower, which he also hates, I mix in instant mashed potatoes for his portion. That he enjoys. Even cooking for a family can be ok, with just a few modifications.

Hi @KBJ86 thanks for your reply, that was so helpful. I’m having a hard time because my Drs keep telling me im in a good range and better than their other patients. I did a new A1C Monday and it came out at 7.7, so I need to take things into my own hands adjusting diet and what not if Im going to get where I want to be, which is at or below 6.0 like you. I just ordered the book you suggested. thanks for your help!

There are some other really valuable books out there, too. But that’s a perfect one to begin with.

Who cares if you’re “better than their other patients”? Ugh, that’s not how your doc should be assessing your management. They’re not the ones who have to live with the highs and lows of having diabetes - it’s hard to imagine any doctor really understanding what we go through unless they have type 1 themselves.

Future complications scare the heck out of me, but honestly, how crappy I feel when my blood sugar is out of range is just as motivating for me to keep working on my management so I don’t have to deal with those symptoms.

Perfect example: yesterday I forgot to plan ahead and bring a lunch for the day. I had a limited amount of time and the only option at the time was Subway, so I said, whatever it’s fine, I’ll just pre-dose a little early and check my sugar more frequently to make sure I’m ok. Well, 45 min later I’m at 228. I’m so scared of being that high that I give myself a little more insulin and hope that it’s the right decision. By the time I’m ready to drive home an hour later, my sugar is plummeting. It’s not low yet, but it’s getting there way too fast. So I pop some glucose tabs and stop by a nearby grocery store before I get on the freeway. I then sit in the parking lot shoveling food down my throat for 45 min until my sugar starts to go up instead of down and I feel comfortable driving. I get home an hour later and I’m high again.

This is why I can’t do bread, lol. It makes me spike faster than my insulin can cover, and then I freak out an anger-correct and always regret it. I hate how high blood sugars (and lows) affect my judgment and how eating a simple sandwich makes me lose 2-3 hours of my day because I have to deal with a blood sugar roller coaster.

Rant over, haha.

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This is where afrezza changed my life. Eat and then get on with your day with minimal fuss and reasonably healthy bg levels, just like everyone not dealing with this day in and out… It truly is a game changer!

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I heard the smallest dosage of Afrezza you can take is 4 units. Is this true? I usually only take 1-2 units of insulin with most meals.

It’s true that “4u” is the smallest dose of afrezza but it’s not even remotely comparable to 4u of injected insulin. The instructions say to replace anywhere from 1-4u of injected bolus with a 4u afrezza cartridge… I really dislike that they called them “units” with afrezza because that makes everyone correlate them with injected insulin when in reality they’re a totally different animal…

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Ohhhh, interesting. Hmmm that does make it way more appealing. Maybe I’ll mention it to my Dr when I see him next week and see if he would prescribe it. Because hey, my 30th birthday is coming up and it’d be sweet to be able to celebrate with a margarita (pun intended).